title: Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study.
abstract: OBJECTIVE
  We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors.
  
  
  METHODS
  Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed.
  
  
  RESULTS
  We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects.
  
  
  CONCLUSIONS
  Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.
authors.affiliation: Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
authors.forename: Micol E
authors.initials: ME
authors.lastname: Gianinazzi
authors.forename: Corina S
authors.initials: CS
authors.lastname: Rueegg
authors.forename: Nicolas X
authors.initials: NX
authors.lastname: von der Weid
authors.forename: Felix K
authors.initials: FK
authors.lastname: Niggli
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
authors.forename: Gisela
authors.initials: G
authors.lastname: Michel
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D035781:Siblings; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013557:Switzerland / Q000453:epidemiology